Introduction: The authors present the first experience in neonatal magnetic resonance imaging (MRI) examinations using an MR compatible incubator (INC) at the Institute of Mother and Child.

Material and methods: Forty-nine examinations of 47 newborns (20 girls, 27 boys) were performed using the GE Signa HDxt 1.5T system and INC Nomag IC 1.5. Demographic data, anesthetic methods and MRI findings in the INC in comparison with previously performed imaging were analyzed.

Results: Thirty-two neonates were prematurely born (68.1%) at gestational age 23&ndash;37 weeks, mean: 29.9 weeks. They were examined at 26 weeks postmenstrual age to 1 month corrected age, mean: 37.5 weeks. Body weight of newborns on the study day was 600&ndash;4300 g, mean: 2724 g. Seventeen (34.7%) children were examined in physiological sleep, 32 (65.3%) anesthetized. In none of them did anesthesiological complications or disease worsening occur. In 43 (91.5%) children brain MRI was performed, in 4 (8.5%) MRI of the spinal cord and canal and of the abdomen/pelvis. In children prenatally examined by MRI, the INC provided new diagnostic information in 5 (83.3%) cases, in neonates studied after birth by ultrasound in 32 (82%). Magnetic resonance imaging in the INC did not entail additional knowledge in 9 (18.7%) cases.

Conclusions: The INC enables MRI in preterm newborns and those with low/extremely low body weight. These studies are necessary to assess the extent of changes in the central nervous system and other organs. Incubator coils, designed specifically for neonates, allow more accurate diagnosis than previously used coils for adults. MRI results allow one to determine prognosis, for more accurate planning of diagnostics, helping to make appropriate therapeutic decisions.

Figure 0003: Term male neonate examined at the age of 6 days, body weight 2600 g. Pathological gyration (pachygyria) and abnormally myelinated white matter of the brain. Note the superior sagittal sinus abnormality (A). The thin slices show the thrombus in the transverse sinuses: brighter in comparison with the blood before the administration of contrast medium (B) and darker (without contrast enhancement) after its administration (C)

Mentions:
Magnetic resonance imaging in an unstable clinical condition in premature neonates (when the infant requires a constant infusion of catecholamines due to severe hypotension which is difficult to correct) is performed very rarely, in order to establish the prognosis for survival when the sonographic picture of the brain is unclear. More accurate MRI assessment may have a significant impact on the further management. In term newborns it is easier to decide to perform MRI, even if their condition is unstable. If brain damage which is partially visible on ultrasound shows a wider range (e.g. bilateral and extensive periventricular venous infarcts), or if the effects of severe perinatal hypoxic-ischemic encephalopathy are not yet visible on sonography (and these may be extensive cortico-subcortical lesions and/or bilateral thalamic injury), their visualization by MRI is essential and can – in the presence of serious neurological symptoms – lead to important decisions as to further management because the prognosis for survival and development of the child is then serious. Magnetic resonance imaging of the brain allows detection of additional pathologies such as venous sinus thrombosis in which early treatment significantly improves the prognosis. In the standard US procedure detection of cerebral venous thrombosis is impossible; therefore it is very rarely recognized, and its prevalence is underestimated. In our study there were as many as 4 babies with thrombosis (4/47, i.e. 8.5%). It should be noted that venous sinus thrombosis may occur as an isolated disease or coexist with hypoxic-ischemic changes or bleeding, which occurred in 3 of our patients. In the fourth case the acute extensive thrombosis worsened the already very bad in utero child's neurological condition resulting from the coexistence of brain malformation (pachygyria) and impaired myelination (Figure 3). The results of MRI in this patient facilitated planning of metabolic and genetic diagnostics and allowed determination of prognosis and assessment of the chance of survival – in this case it was decided to implement palliative treatment only.

Figure 0003: Term male neonate examined at the age of 6 days, body weight 2600 g. Pathological gyration (pachygyria) and abnormally myelinated white matter of the brain. Note the superior sagittal sinus abnormality (A). The thin slices show the thrombus in the transverse sinuses: brighter in comparison with the blood before the administration of contrast medium (B) and darker (without contrast enhancement) after its administration (C)

Mentions:
Magnetic resonance imaging in an unstable clinical condition in premature neonates (when the infant requires a constant infusion of catecholamines due to severe hypotension which is difficult to correct) is performed very rarely, in order to establish the prognosis for survival when the sonographic picture of the brain is unclear. More accurate MRI assessment may have a significant impact on the further management. In term newborns it is easier to decide to perform MRI, even if their condition is unstable. If brain damage which is partially visible on ultrasound shows a wider range (e.g. bilateral and extensive periventricular venous infarcts), or if the effects of severe perinatal hypoxic-ischemic encephalopathy are not yet visible on sonography (and these may be extensive cortico-subcortical lesions and/or bilateral thalamic injury), their visualization by MRI is essential and can – in the presence of serious neurological symptoms – lead to important decisions as to further management because the prognosis for survival and development of the child is then serious. Magnetic resonance imaging of the brain allows detection of additional pathologies such as venous sinus thrombosis in which early treatment significantly improves the prognosis. In the standard US procedure detection of cerebral venous thrombosis is impossible; therefore it is very rarely recognized, and its prevalence is underestimated. In our study there were as many as 4 babies with thrombosis (4/47, i.e. 8.5%). It should be noted that venous sinus thrombosis may occur as an isolated disease or coexist with hypoxic-ischemic changes or bleeding, which occurred in 3 of our patients. In the fourth case the acute extensive thrombosis worsened the already very bad in utero child's neurological condition resulting from the coexistence of brain malformation (pachygyria) and impaired myelination (Figure 3). The results of MRI in this patient facilitated planning of metabolic and genetic diagnostics and allowed determination of prognosis and assessment of the chance of survival – in this case it was decided to implement palliative treatment only.

Introduction: The authors present the first experience in neonatal magnetic resonance imaging (MRI) examinations using an MR compatible incubator (INC) at the Institute of Mother and Child.

Material and methods: Forty-nine examinations of 47 newborns (20 girls, 27 boys) were performed using the GE Signa HDxt 1.5T system and INC Nomag IC 1.5. Demographic data, anesthetic methods and MRI findings in the INC in comparison with previously performed imaging were analyzed.

Results: Thirty-two neonates were prematurely born (68.1%) at gestational age 23&ndash;37 weeks, mean: 29.9 weeks. They were examined at 26 weeks postmenstrual age to 1 month corrected age, mean: 37.5 weeks. Body weight of newborns on the study day was 600&ndash;4300 g, mean: 2724 g. Seventeen (34.7%) children were examined in physiological sleep, 32 (65.3%) anesthetized. In none of them did anesthesiological complications or disease worsening occur. In 43 (91.5%) children brain MRI was performed, in 4 (8.5%) MRI of the spinal cord and canal and of the abdomen/pelvis. In children prenatally examined by MRI, the INC provided new diagnostic information in 5 (83.3%) cases, in neonates studied after birth by ultrasound in 32 (82%). Magnetic resonance imaging in the INC did not entail additional knowledge in 9 (18.7%) cases.

Conclusions: The INC enables MRI in preterm newborns and those with low/extremely low body weight. These studies are necessary to assess the extent of changes in the central nervous system and other organs. Incubator coils, designed specifically for neonates, allow more accurate diagnosis than previously used coils for adults. MRI results allow one to determine prognosis, for more accurate planning of diagnostics, helping to make appropriate therapeutic decisions.